CHD.(coronary heart disease care and prevention objectives and their implications for nursing)

One year after the launch of the national plan for management of coronary heart disease, Jennifer Mussenden looks at what nurses can do in primary care to meet the targets it set.

KEY POINTS

* Coronary heart disease is one of the targets of the national service framework (NSF) strategy

* The NSF brings opportunities to expand the role of nurses in primary care

* Nurses must consider their training needs and their confidence to lead in this area of care

Action plans aimed at tackling poor health and health inequalities form a major part of the Government's strategy for the NHS. At the same time, there is an emphasis on providing services and treatments that are evidence-based.[1]

There are four priority areas at the heart of this strategy:

* cancer

* mental health

* accidents

* coronary heart disease and stroke.

Each area is a major cause of premature death and poor health, with marked inequalities in the standards of care. Each has a wealth of evidence demonstrating effective ways of improving prevention and/or treatment.

They are all being addressed through the development of clear standards of evidence-based care. For mental health and coronory heart disease this standardisation is being done through publications called national service frameworks (NSFs). Cancer and accidents are being addressed in other ways. These publications are produced by the National Institute for Clinical Excellence (NICE) with the objective of improving and standardising the care offered throughout the NHS. NSFs on diabetes and older people are due to be published later this year.

Ultimately, the frameworks should bring an end to postcode healthcare, and make sure every patient receives high-quality treatment. The job of assessing the extent to which these standards are achieved is the responsibility of the Commission for Health Improvement.

At local level, health improvement programmes have been developed by every health authority and primary care group (PCG). The purpose is to identify local needs and translate the national standards into action plans for the area through a collaborative partnership with all the key agencies.

WHY CORONARY HEART DISEASE?

Coronary heart disease (CHD) was the first priority area to come under the NSF spotlight, last March.[2] There are several compelling reasons for this:

* The UK has one of the worst rates of CHD in the western world.

* Forty six per cent of CHD-related deaths occur in people with established disease, so improving secondary prevention would have a significant impact on overall CHD mortality.[3]

* Many people do not receive or act on advice aimed at reducing the risks of cardiac ill health.

* Many patients do not receive treatments of proven effectiveness.

* There are unjustifiable variations in the quality of and access to CHD services across the country.

The Government …